Factors associated with quality of life in patients with heart failure and its impact on mortality

BACKGROUND: In heart failure (HF), patients' quality of life (QoL) is influenced not only by cardiac function but also by coexisting conditions. Despite the widespread use of QoL assessments, the role of patient-related factors as determinants of QoL remains not fully elucidated. AIMS: This study aims to assess the relative impact of different factors on QoL in HF patients, also its impact on mortality in this group. METHODS: The study was based on the national registry - HEart failuRe ObsErvational Study of the Polish Cardiac Society, where QoL was assessed at baseline (Kansas City Cardiomyopathy Questionnaire [KCCQ]-12), and follow-up data on all-cause mortality were obtained. Adjusted linear regression was used to identify factors associated with KCCQ-12. RESULTS: The study included 1397 patients with a mean KCCQ-12 score = 47.92 (28.65-72.92). Higher New York Heart Association class had consistently significantly lower values of all KCCQ-12 domains and KCCQ-12 overall score (85 [69-93] vs. 65 [46-79] vs. 35 [23-49] vs. 21 [10-38]; all P <0.001). Hospitalized patients had significantly lower KCCQ-12 overall score, with a significant difference between patients hospitalized for HF or non-cardiac reasons and patients hospitalized for other cardiac conditions. Apart from visit type, individual factors, cardiovascular conditions, and non-cardiac conditions were independently associated with KCCQ-12. KCCQ-12 also significantly influenced all-cause mortality (hazard ratio per 1 point increase = 0.976; 95% confidence interval, 0.970-0.981; P <0.001). CONCLUSIONS: Individual factors with both cardiac and non-cardiac comorbidities are independently associated with QoL in patients with HF. The KCCQ-12 integrates all of these factors and may serve as a simple, easily accessible tool for prognostic assessment.